From my perspective, if, with the +3, if the eyes do not cross, have
equal acuity and no amblyopia and she is not experiencing vision
discomfort with the reduced Rx, then stay with that and re-check the
previously mentioned issues in 6 months.

(I'd probably move it to +3.75 or 4 at the 6 month point if it is still
+5, but not if the plus is less.)  If by the time she is learning to
read, even spending time with books  (they like to pretend that they're
reading-----and they sort of really are!), and that might be very soon.
and she still measures +5, I'd start moving the power up to that level
or close to it. And I'd consider contact lenses---another controversial
discussion.

So both docs are reasonably correct, as the final answer is age and
learning dependent. It is certainly possible that not using the full +5
might result in the eyes becoming somewhat less hyperopic.  She might
end up somewhere between +3 and +5, so it is reasonable to "let nature
be" for a while and see what happens.  If that "missing" 2 diopters is
not doing any harm, it is reasonable to just follow up in 6 month
intervals.

Meanwhile, encourage her to draw/color/read with the near objects as far
away from her face as practical (considering her cute little arms aren't
all that long!).  And watch her to see if her eyes cross, if she rubs
them or blinks unusually or gives up the task too quickly.  

Then call the doctor.

I hope that helps!

--LB

Dear Mary,

You will receive "explosive" opinions about what
should be done.

I would first verify that your daughter can read
the standard eye chart at 20 feet.

The range of accommodation for a very young
child is about 11 diopters.  Therefore
your child should be able to see things
a 10 inches with no problems.

There is a "philosophy" about the eye
that states that the child's eyes
are still growing, and as such, the
refractive status will gradually
move towards a normal +2.0 diopters -- if
you do not put a plus lens on her at that
age.

A promenant optometrist (    ) recommended
that the plus be kept off a child if there
are no other "problems".

I am an engineer, so I am certain the
ODs will "jump on" this opinion.

If it were my daughter or son -- I would
follow the "second opinion" -- but
you asked for a "balance" of opinions.

Best,

Otis
Engineer

*****

The current prescription is quite reasonable, consistent with what most
doctors would do.

It leaves her with +2.00 uncorrected, but that's actually comfortable for
her and a refractive state of +2.00 is often considered "normal" for kids
her age. They don't usually have symptoms or developmental consequences.

Her eyes are still growing; reaching adult size around 12. *If there is* any
tendency to "grow out of" hyperopia, partial correction alleviates symptoms
but leaves some stimulus for that to happen.

-MT, OD

Excuse me, but, what credibility have those optometrists?

They don't even make things safe with their own theories!

The measured +5, but prescribed +3... Because they are afraid of what
+5 may do injuring the eyes even more.

They do not know what they are doing.

Indeed it's a strange world.

Medical men, who are thought by the common people to be people of
knowledge, are in fact much ignorant.

What to do?

NOW, imagien you did not go to any optometrist.

what would have happened to your girl?

Dear Mary,

Question:

Since you state she was wearing a +3.0 diopter lens -- I wonder
why she was.

What was the original reason?  Crossed eyes.
Amblyopia, or just "hyperopia".

Best,

Otis
Engineer

"Mary Daniele" wrote

Larry Doc and Mike Tyner have given you excellent advice, IMHO.

I was born with a pretty complex set of eye problems including
strabismus (alignment) and high hyperopia (farsightedness).  At 40,
I'm having severe problems with my eyes and can no longer read without
pain, blurring, and nausea.

If I were born today, and were treated by the right doctors, it's
likely that my tale would have ended quite differently.  I've spent
years researching my particular issues.

You may want to read this document:

    http://www.aoa.org/eweb/Documents/CPG-16.pdf

At +5.00d, your daughter is a borderline 'high hyperope.'  While this
certainly doesn't kill people, it can be associated with a number of
other visual issues.

If I knew then what I know now, here's what I'd do differently:

- Make sure they've determined _exactly_ how much farsightedness your
daughter has.  This is done via cycloplegia (dilating drops).  That's
likely already been done, but it's important.  If it were my daughter,
I'd talk to the doc's about using Atropine.  It's the grand-daddy of
cycloplegics;

- Vision therapy.  Your daughter's going to have to do a lot of
accommodating (focusing) in her life.  We aren't hunter-gatherers any
more; this is the information age.  It's all books and computers.  A
qualified vision therapist can help your daughter develop both her
focusing power and her 'binocular vision.'  Binocular vision is the
eyes working together.  This has both a physical component (straight
eyes) and a neurologic component (developing the mechanism for
fusion)--the mind has to learn to take two images and see them as one.
That has to happen early in life (now);

- A pediatric strabismus ophthalmologist should be in your arsenal.
Alignment issues (crossing or turned out eyes) can often be associated
with this kind of farsightedness.  You want to monitor that closely as
your daughter grows up.  The course of treatment varies if the eyes
start to have alignment problems.  The vision therapist can work with
this, too.  Again, the goal is to ensure that her eyes work properly
_together_ (binocular vision).

- Contact lenses?  _Absolutely_.  I'd ignore the controversy.  Here's
why: 1) in farsighted people, contact lenses place a lower
'accommodative demand' than eyeglasses.  In other words, contacts are
easier on her eyes; 2) eyeglasses induce alignment errors and optical
distortion that contacts don't; 3) kids' glasses slip around, get
bent, etc.  When this happens, the correction tends to change (in
other words, the prescription is only right when the glasses are
straight and sitting properly on the face).  This can cause blur,
placing additional load on her focusing system;

Best of luck, Mary.  I'm sure she'll be fine.

Neil